Four Core Cases: A Simulation Curriculum for Pediatrics Residents

Introduction This is a syllabus of a longitudinal simulation curriculum designed to teach pediatric residents the basic skills and behaviors of pediatric resuscitation. Goals of the curriculum are to develop proficiency with basic pediatric resuscitation algorithms, skills, and select procedures; leadership and communication skills for multidisciplinary crisis resource management; and confidence with acute resuscitation. Methods The syllabus comprises four pediatric emergency and critical care simulation scenarios: status asthmaticus, status epilepticus, septic shock, and a toxicology case with cardiac arrest. Each scenario was designed as 60− to 75-minute resident conference: introduction (10 minutes), simulation activity (7-15 minutes), debriefing (35 minutes), and repeat of the simulation (7-15 minutes). Repeating the scenario after debriefing, also known as repetitive pediatric simulation (RPS), allowed immediate application of feedback. Performance was assessed using modified versions of the Tool for Resuscitation Assessment Using Computerized Simulation (TRACS). TRACS is a reliable and preliminarily validated tool assessing resident performance in four domains of pediatric resuscitation: basics, airway, circulation and arrhythmias, and behavior. Results The curriculum was piloted from August 2012 through June 2013. Although we piloted all four scenarios, the fourth scenario (toxicologic pulseless electric activity/ventricular fibrillation arrest) was utilized most often, as part of a nested research study comparing the RPS format to standard simulation. Discussion Time was our greatest limitation. Given the multiple demands on resident time, implementation during reliably protected educational time is the most sustainable approach. For programs looking to implement and/or build upon the cases provided here, we suggest utilizing a time slot that is already protected for residents and anticipating a total educational time of 75-90 minutes. Although it adds to the time burden, we highly encourage using the RPS format, given its greater associated learner satisfaction. By providing these resources in one syllabus, we hope the cases may be reproduced, implemented and expanded upon by resident educators.